Americans seek emergency room care nearly 140 million times each year. For doctors and nurses facing these crushing workloads, there is often only one way to cope: “stitch ‘em and ditch ‘em.” Alas, this pragmatic approach ignores a patent’s social needs. And, it turns out, that’s a critical oversight.
Social needs, including food and housing, play a role in up to 75% of health outcomes, according to the U.S. Office of Disease Prevention & Health Promotion. As a consequence, many patients with unmet needs rebound into ERs over and over again. In fact, up to 25% of patients use ERs as their usual source of medical care, in part because patients can’t be denied treatment for inability to pay. Research suggests that reducing these recurrent ER visits through referrals to social service agencies could slash emergency room costs and increase efficiency.
But how? In a recent preliminary study, University of Utah researchers decided to ask the patients themselves.
The scientists developed and tested a new tool that assesses the social needs of ER patients and, if necessary, refers them to up to 46 community resources available through United Way 211 (UW211), a nonprofit emergency services referral hotline.
Overall, they found 61 percent of the 210 patients surveyed had one or more unmet social need, such as not having enough money for food, clothing, or medical care. More than half of these respondents asked for referrals to social service agencies. The finding suggests that universal screening and referrals for social needs in ERs is not only practical but should be a part of regular emergency room protocols.
“People seeking care in emergency rooms face many circumstances in their personal lives that are barriers to remaining healthy after they receive care,” says Andrea Wallace, the study’s lead author and chair of the Division of Health Systems and Community Based Care in the College of Nursing at University of Utah Health. “The truth is, we can do everything we can for patients in the context of emergency room care, but it’s not going to matter if they can’t properly engage in self-care after they leave.”
The researchers created a 10-item questionnaire that could be filled out in less than 90 seconds by either ER registration staff or patients themselves. The questions were designed to assess social needs in nine categories: housing and utilities; food assistance; transportation needs; medical, dental, and vision insurance; employment; education and training; and child care and elder care.
The questionnaire, which was available in both English and Spanish, asked participants—many of them low-income or uninsured—about their needs over the past year. These questions included, “In the past 12 months, have problems getting child care or elder care made it difficult for you to work or get to appointments?” The assessments were gathered over four months in 2017 and 2018 at University of Utah Hospital.
Patients who requested further information received an average of four referrals from UW 211. Most commonly, they received health care referrals (community clinics, prescription drug discounts) as well as those for utilities, transportation, and children’s charities.
The study has several limitations, including that it was conducted at only one hospital ER, most of the participants were white, and registration staff occasionally skipped screening patients because they had insurance, were well-groomed, or appeared to be financially secure.
“The point of this small study was to see if we could conduct initial social needs screening in the ER with existing resources, then have follow-up conducted by community-based agencies,” Wallace says. “We plan to conduct larger, more diverse studies to determine if and how this concept can be integrated into other hospital settings, and whether it benefits patients.”